Civil Court of the City of New York

Adult Name Change Petition Program

Because of your answers to the program, these are the documents you need:

Instructions for how to complete and how to file your Name Change Petition
AName Change Petition

NYS DIY Forms User Survey

Instructions for how to complete
And how to file the Name Change Petition

1. Read the Petition carefully. Make sure that all the information you gave is correct.
Fix any mistakes before you print the Petition.
2. Do not fill in the Index No. at the top. Its in the right hand corner. That will be
done at the courthouse.
Notarization and Verification
1.
2.
3.
4.

Take the Petition to a Notary Public.

Sign the Petition on the blank line above your name.
Write the date that you are signing the Petition on the blank line that says Date.
After you do this, read the Verification. The Verification says that you have read the
Petition and the words are true. If this is true, sign the Verification on the blank line
above your name. Dont sign it before you get to the Notary Public because they
have to see you sign it. The Notary will fill in the county, date and notarize the
Petition.

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Documents and Proof to Bring to Court

1. You must prove the date and place where you were born. If you were born in the
State of New York you must attach a certified copy of a Birth Certificate, it will have
a raised seal (a bumpy logo) of the local government agency, or bring a Certificate
from the Commissioner or the local Board of Health that no such Certificate is
available.
If you were born in the City of New York, you can get a certified copy of

your birth certificate from the Office of Vital Records, Department of

Public Health, 125 Worth Street, New York, New York 10013.
If you were not born in New York City, but in the State of New York, you

can get a certified copy of your birth certificate from your local City Hall for
$15.00. It takes about two weeks by mail. Or you can get it from the New
York State Department of Health, Empire State Plaza, Albany, New York
12237. The cost is $30.00 and takes about 10 weeks by mail.
2. If you have been convicted of a crime and you served your sentence, you can
choose to attach a copy of the Certificate of Incarceration or Certificate of
Disposition.
3. If you have had bankruptcy, you can choose to attach a copy of the judgment along
with the Petition.
4. If you have any legal judgments or liens, you can choose to attach copies to the
Petition.
5. If you are a part of any other court cases, you can choose to attach copies of the
court papers.
6. Remember that any documents you give to the court will be part of the court record
and you will not get them back, so make copies before coming to the courthouse.
7. The Judge can require that you give copies of any of the documents on this list.
8. The Judge may ask for additional information or documents that are not on this list.
Filing the Petition and Publication
1. Make a copy of the Petition for yourself.
2. Bring your completed name change Petition, the completed NYS DIY Forms User
Survey, and the documents on the list to the Civil Clerks Office in the courthouse
located at: 111 Centre Street, County of New York.

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3. If your papers are correct, the Clerk will file your Petition with the Court. You will
have to pay the $65.00 filing fee. The fee must be paid by cash, certified check,
money order or bank check. Personal checks will not be accepted.
4. If you do not have money to pay the court costs and fees, you can ask the court to
let you to continue without paying the court costs. This is called Poor Persons
Relief. To learn more you can visit:
http://nycourts.gov/courts/nyc/civil/poorrelief.shtml on the computer. But, you will still
have to pay for any fees that the newspaper charges to print your name change.
5. A Judge will read your papers and decide yes or no to allow the change of name.
6. If the Judge agrees to your name change Petition, you will have to put a notice of the
change of name in at least one newspaper that the Court approves. The
newspaper(s) will charge you a fee for this service.
7. The Judge can also require that you tell other parties like:
United States Citizenship and Immigration Services
Selective Service System
Your wife or husband (if you are only changing your name)
An ex-wife or husband
Bankruptcy Court
New York State Criminal Justice Services

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Any other party the Court thinks should be notified. Civil Court of the City of New

York
County of New York
In the Matter of the Application of

Index Number__________
PETITION FOR
INDIVIDUAL ADULT
CHANGE OF NAME

DANNY XIAO YANG LIAN,

For Leave to Change His Name To

DANNY LIAN,
_____________________________________

Danny Xiao Yang Lian, by this petition alleges:

1.

My present name is Danny Xiao Yang Lian.

2.

I would like my new name to be Danny Lian, in place of my present name.

3.

I am 18 years old. I was born on September 2, 1996.

4.

I was born in New York, NY, USA.

5.

I currently live at 651 61Street 7AV Brooklyn NY 11220.

6.

I have never been convicted of a crime.

7.

I have never declared bankruptcy.

8.

There are no judgments or liens against me.

9.

I am not a party to any actions or proceedings.

10.

I do not have any obligations to pay child support.

11.

I do not owe any child support.

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Petitioner for Individual Adult Change of Name

Page 4 of 5

12.

I am not responsible for spousal support.

13.

I have not made a previous application to change my name in this or any other court.

14.

I want to change my name for the following reason(s):

I do not like my middle name.

WHEREFORE, your Petitioner respectfully requests that an Order be granted permitting

this change of name.
____________________________
Date
__________________________________________
Danny Xiao Yang Lian

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Petitioner for Individual Adult Change of Name

Page 5 of 5

______________________________________________________________________________
VERIFICATION
State of New York, County of ___________________ ss.:
Danny Xiao Yang Lian, being duly sworn, deposes and says:
he is the petitioner named above, that petitioner has read the petition and knows the truth of the
contents thereof except for those matters alleged to be on information and belief, and as to those
matters, petitioner believes them to be true.
__________________________________________
Danny Xiao Yang Lian
Sworn to before me this _____ day of __________, 20____
______________________________________
Signature of Notary Public

NYS DIY Forms User Survey

Thank you for taking the time to fill out this quick survey. Please return it with your completed papers.
1. How comfortable are you using a computer and/or the internet?
Not comfortable
Comfortable
Very comfortable

2. Do you have the internet at home?

Yes.
No.

3. Where did you use this program?

Home
Court Clerks Office
Court Help Center
Court library
Work
Other: ____________________________________

4. Were the questions, definitions and learn mores clear to

understand?
Yes.

7. Do you think the DIY program saved you time?

Yes.
No.
8. How did you learn about this program?
Word of mouth
Internet search
Court employee
Poster, sign, postcard, etc.
Other: ____________________________________
9. We really appreciate your help. Do you have any suggestions or
comments to add?
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

No. Which werent clear? ____________________________

_________________________________________________

5. Did you listen to the guide speak during the program?

Yes.
No.
6. Have you used a court DIY Forms program before?
Yes. Which ones? __________________________________
____________________________________________________

No.
Office Use:
Court Clerk: Forward to the Assistant Deputy Chief Clerk of the County.
New York County NYC Civil adult name change printed on February 17, 2015

NYS DIY Forms User Survey

Thank you for taking the time to fill out this quick survey. Please return it with your completed papers.
10.

Optional questions:

1. How old are you?

Between 18 and 24
Between 25 and 34
Between 35 and 44
Between 45 and 54
Between 55 and 64
65 or older

2. What is your annual income?

Less than $19,999
$20,000 to $34,999
$35,000 to $49,999
$50,000 to $64,999
$65,000 to $79,999
$80,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 or more

Office Use:
Court Clerk: Forward to the Assistant Deputy Chief Clerk of the County.
New York County NYC Civil adult name change printed on February 17, 2015